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Europe/Vienna
Description

The conference will give health care professionals an opportunity to review the current developments in clinical applications in the fields of radiation oncology, radiation biology and medical physics, with a view to addressing the challenge of cancer management in Member States.

It will also critically examine the pivotal role of emerging radiotherapy techniques in tackling the health challenges common to many Member States.

An appropriate number of accredited continuing medical education (CME) credits will be awarded to participants.

Participants
• RITU RAJ UPRETI
• Ruben Gomez
Support
• Tuesday, June 20
• 7:30 AM 9:00 AM
Registration Gate 1

### Gate 1

• 9:00 AM 9:30 AM
Session 1 - Opening ceremony M1

### M1

• 9:00 AM
DDG-NA 10m
• 9:10 AM
DDG-TC 10m
• 9:20 AM
DIR-NAHU 10m
• 9:30 AM 10:30 AM
Session 2 - From ICARO-1 to ICARO-2 M1

### M1

Learning objectives:
2. To understand the challenges in the field of radiation oncology in the near future

Conveners: Dr Eduardo Zubizarreta (Section Head ARBR - NAHU - IAEA) , Mr Geoffrey Ibbott , Ms May Abdel-Wahab (IAEA)
• 9:30 AM
From ICARO1 to ICARO2: the radiation oncologist perspective 30m
Speaker: Eduardo Rosenblatt (IAEA)
• 10:00 AM
From ICARO1 to ICARO2: the medical physicist perspective 30m
Speaker: Geoffrey Ibbott
• 10:20 AM 11:00 AM
Tuesday morning - Poster Presentations - Screen1
Convener: Mr Oleg Belyakov (IAEA)
• 10:30 AM
A centralized model of effective radiation oncology service development:the Azerbaijan Republic experience 5m
Speaker: Isa Isayev
• 10:35 AM
Audit of the radiotherapy waiting times for patients in Malta 5m
***Introduction*** The Radiotherapy Patient Pathway (RPP) outlining the major stages involved from date of patient consultation to treatment was established for Sir Anthony Mamo Oncology Centre (SAMOC) for all patients receiving radiotherapy. Figure 1 below is an illustration of the main stages, as a subset of the RPP, which were included in this audit. An audit of the established RPP was performed to determine the waiting times at specific stages and the overall waiting time. Waiting times were also sub-divided per treatment site. ![Figure 1: An illustration of the main stages of the RPP][1] ***Method*** A sample of 290 patients, based on a 95% confidence interval and 5% margin of error, was randomly generated as a representation of the patient population of 1 year. Records were selected both retrospectively and prospectively over a 7 month period. A proportional sampling method was used to subdivide patients into 6 treatment sites: Palliative; Breast; Prostate; Pelvis; Abdomen/Thorax; Head&Neck. Each patient journey was mapped on the RPP and the date of arrival at each stage was recorded. Statistical analysis was performed to determine the weighted mean, median and mode waiting times for all records analysed. ***Results*** Results indicate an overall total weighted mean waiting time of 36 days with a maximum of 62 days for Prostate and a minimum of 19 days for Palliative. Analysis of the waiting time between specific stages of the RPP showed a total weighted mean of 8 days from Consultation to date of CT scan; 13 days from date of CT scan to arrival at the Medical Physics department; 15 days in the Medical Physics department, and 8 days from the Pre-Treatment stage to the Treatment Date. ***Conclusions*** Methods of decreasing patient waiting times across the RPP should be explored in order to provide a more timely radiotherapy service at SAMOC. Recommendations for a more efficient workflow include the further development of an existing oncology information system MosaiqTM, and developing and re-engineering the organisation structure within the context of a multidisciplinary team. [1]: https://conferences.iaea.org/indico/event/108/call-for-abstracts/39/file/3.jpg
Speaker: Chantelle Said
• 10:40 AM
Trend of availability and use of Intensity-Modulated Radiotherapy(IMRT) in Thailand, statistical report from 2008 to 2015. 5m
Speaker: Poompis Pattaranutaporn (Ramathibodi Hospital)
• 10:45 AM
Radiotherapy in cancer treatment in Ghana: from the past to present 5m
Cancer is a complex disease and should be a concern for all since we are all at risk of any type of cancer at a point in our lives. Early detection coupled with effective treatment is almost impossible without the existence of the requisite equipment and trained personnel. The world has made a huge progress in cancer treatments, research and advocacy and Ghana is no different. Radiotherapy is a form of treatment for cancer that uses carefully measured and controlled high energy X-rays to kill cancer cells. Radiotherapy forms a greater percentage of cancer treatment, which is one of the most cost-effective. Although the number of radiotherapy facilities in the country are inadequate, Ghana has made some strides in the development of its radiotherapy facilities. According to the World Health Organisation, over 50% of all cancer patients require Radiotherapy at one stage or the other in the course of the disease for treatment and 40% of all the cancer cures result directly from the use of Radiotherapy. In Ghana, cancer of cervix is currently the most common cancer among women, and Radiotherapy plays a major role in its management. Radiotherapy is a specialised treatment and is not available in every hospital. In Ghana, Radiotherapy Services can be assessed at Korle-bu Teaching Hospital in Accra, Komfo Anokye teaching Hospital in Kumasi, both public facilities and the Sweden Ghana Medical Centre in Accra which is a private centre. Radiotherapy was introduced to Ghana in 1992 when the first radium brachytherapy was performed with the aid of the German Government. Before this, there had been unsuccessful attempts to establish a radiotherapy centre in Ghana since 1960. During that period a cobalt machine was donated by the Canadian Government to be used for medical purposes. However, because of lack of funds to house it, the machine was donated to the Lagos University Hospital in Nigeria. Korle-bu Teaching Hospital radiotherapy centre became operational in 1997 and the Komfo Anokye Teaching Hospital radiotherapy centre started treatment in June 2005 both with a strong support from the International Atomic Energy Agency through the Ghana Atomic Energy Commission. Presently, external and internal radiotherapy are available at both hospitals with low dose rate (Cesium-37) in Kumasi and high dose rate (cobalt-60) in Accra. The Korle-Bu and Komfo Anokye Teaching Hospitals’ Radiotherapy Centres now provide a comprehensive service, treating over 1000 patients a year. A lot of patients have been treated so far with radiotherapy in Ghana, over a quarter of whom are women with cervical cancer. Many of them are farmers especially at the Komfo Anokye Teaching Hospital.The high number of patients is further exacerbated by the fact that the neighbouring countries of Côte d’Ivoire, Burkina Faso, Togo, Benin and Sierra Leone have no Radiotherapy treatment facilities of their own. Hence most of their cancer patients who require radiotherapy are referred to Ghana for treatment. The establishment of these centres have also reduce the number of patients who travel abroad for radiotherapy services. Ghanaians can therefore have the luxury of being treated in the country by fellow Ghanaians. Due to the high cancer cases coupled with lack of accessibility and modernisation in Radiotherapy practice there is the need for further development in this specialty. The Population of Ghana has since increased from the time this centres were established. The population of Ghana is currently estimated to be approximately 25million, with a male to female ratio of 49:51. Where a 70% of this population is living in the south of the country with the majority of these, living in the Ashanti and Coastal regions. The two major radiotherapy centres are 250km apart making accessibility a challenge. In response to this challenge the Government of Ghana recently acquired a 13.5 million from the OPEC Fund and the Arab Bank for Economic Development in Africa for the upgrading and expansion of the two radiotherapy centres in Accra and Kumasi. Under this expansion project, the old cobalt units are being replaced with 2 Linacs and a new cobalt unit. A 6 MV Linac along with the new cobalt unit are being installed in Accra, while a dual energy 6/10 MV Linac is being installed in Kumasi. Due to the advancement in radiotherapy, linacs are mostly the standardised machines used in all modern Radiotherapy Centres in the World. Moreover, other obsolete equipment will be replaced and the human resource will be strengthened. In all these the IAEA has been very instrumental with alot of projects in the country. Currently two staffs of Komfo Anokye Teaching Hospital are currently on International Atomic Energy Agency fellowship on advance radiotherapy training in partnership with the International Centre for theoretical physics(I.C.T.P) in Italy. Speaker: Emmanuel Worlali FIAGBEDZI (Komfo Anokye Teaching Hospital) • 10:50 AM The risk for developing a second primary tumor in long surviving cancer patients 5m Introduction: Survival rate in cancer patients has increased in recent years and it is still growing. In these patients, there is a significant risk for developing a second primary tumor because of risk factors like genetic background, unhealthy behaviors or side effects from the therapy of first cancer. The goal of this study was to evaluate the frequency of incidence of different cancer types diagnosed in readmitted long-term survivors. An additional goal was to assess the risk for developing a metachronous cancer in patients with long-term survival. Methodology: From the patients admitted tothe Oncology Insitute, Cluj-Napoca,Romania, in 2014-2015,we selected only those patients who were first admitted to the same inistitute at least 5 years prior to 2014-2015. For these patients we evaluated the reasons of the first presentation, as well as those for the 2014-2015 readmission. Furthermore, we analyzed every case with metachronous tumor by considering the location of the first and second primary tumour. Results: Between2014 and 2015 a total of 5080 cancer patients were admitted to the Oncology Institute Cluj-Napoca, Romania. 110 (2.17%) of these patients were first admitted more than 5 years ago. 25 (22.7%) of these 110 patients had no signs of oncologic disease, 21 (19.1 %) had a continuous disease progression, 20 (18.2%) had a relapse after a free disease period, and 44 (40%) had a second primary tumor. Median age in this group was 65, with a median survival of 12 years after the diagnosis of the first malignancy. The female to male ratio F : M was 1.3:1. In the men’s subgroup, head and neck cancers were found in 11 patients (23% of the cases), lung cancer in 7 (14.6%), central nervous system cancer in 5 (10.4%), and each of colon and urinary bladder cancer in 3 (6.3%) patients. In the women’s subgroup, breast cancer was diagnosed in 14 patients (23.3% of the cases), cervical cancer in 8 (13.3%), endometrial cancer in 7 (11,7%), ovarian cancer in 6 (10%), and each of head and neck and soft tissue cancer in 4 (6,7%) cases. In men with long-term survival (more than 5 years), 45% of those who were previously diagnosed with head and neck cancer developed in time a second primary cancer (5 of 11). Similar results for lung and prostate cancer patients were 28.5% (2 of 7) and 25% (2 of 8) respectively. None of the 5 cases of long term survivors of brain tumors developed second cancer. In the women’s subgroup, 12 of 14 (85%) of the patients who had breast cancer were diagnosed with a second malignancy. The corresponding data for cervical cancer was 4 of 8 (50%), for endometrial cancer 3 of 7 (42.8%), and for ovarian cancer 1 of 6 (16.66%).When common primary cancer sites are compared for both sexes, head and neck cancer was found to be significantly more frequent in men (23% vs 6.7%, p=0.01); for lung cancer it was (14.6% vs 3.3%, p=0.03) and for urinary bladder cancer it was 6.3% vs 0%, with a p value of p=0.05. Conclusion: 4 of 10 of the long-term survivors readmitted in the Oncology Institute were diagnosed with a second malignancy. In men, the most frequent first cancer was head and neck, and breast cancer was women's most frequent malignancy. A comparison of common cancer sites for both sexes show the following: head and neck, lung and urinary bladder cancers were more common in men. Almost half of the men surviving for more than 5 years after being diagnosed with a tumor on the head and neck were diagnosed with a second cancer. The same situation was found for almost a third of the men who were previously diagnosed with lung cancer and a quarter of those who were previously diagnosed with prostate cancer. In women, the reason for readmission for 85% of the patients with breast cancer diagnosis more than 5 years ago was the occurrence of a second primary tumor. Cervical cancer and endometrial cancer also represented an increased risk (around 50%) of developing a new primary cancer. Speaker: Monica-Emilia Chirila (Institute of Gastroenterology, Department of Internal Medicine, Cluj-Napoca, Romania) • 10:30 AM 11:00 AM Coffee break and e-Poster presentations 30m • 10:30 AM 11:00 AM Tuesday morning - Poster Presentations - Screen2 Convener: Mr Oleg Belyakov (IAEA) • 10:30 AM Cost of radiotherapeutic management of patients with cancer in regional cancer center in India 5m Introduction: With around 10,00,000 new patients with cancer annually, India accounts for more than half of burden of cancer patients in developing countries. Multi-modality management of cancer, technologic and skill intensive diagnosis and therapy causes significant strain on already burdened health-care system of developing countries. Grant-in-aid is provided by government, various national and international organizations to facilitate prevention and management of cancer in resource-poor countries like India. However optimal utilization of these resources requires computation of cost of cancer management of individual cancer by site / system and histology. Political pressure has become drivers in reducing waiting time and provision of any radiotherapy to patients presenting to oncology centers. In such milieu, we need to compute the cost of radiotherapy in developing countries to plan for future budget outlay and investment. Methods: Data regarding technology/technique required to start any radiotherapy for patients with cancer was obtained from radiotherapy planning register. Data of patients with cancer treated by single radiation oncologist in Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore from August 2012 to October 2016 was collected. Results: Cost of 3D conformal radiotherapy management of 12 pediatric tumor, 50 brain tumors, 70 head and neck cancer, 20 thoracic malignancies, 6 breast cancer and 5 gynecologic malignancies were INR 2,40,000, 32,10,000, 53,40,000, 15,00,000, 4,10,000 and 3,40,000 respectively. Cost for radiotherapy management of around 480 patients is 8400000, 1080000, 1176000 and 192000 for Co-60 teletherapy, HDR brachytherapy, LDR brachytherapy and x-ray simulation respectively. Conclusion: 3D conformal radiotherapy for nearly 160 patients costed INR 1,10,40,000 and treatment by Co-60 teletherapy for management of 480 patients costed INR 8400000 over the period of four years. Treatment by 3D conformal radiotherapy is 3 to 4.5 times more expensive that that by Co-60 teletherapy equipment. However, malignancies of brain, lung, nasal cavity, nasopharynx, stomach, pancreas, gall bladder, prostate, pediatric tumors are best managed by 3D CRT or IMRT. Speaker: Ramaiah Vinay Kumar (Kidwai Memorial Institute of Oncology) • 10:35 AM Photon boost after lumpectomy in breast cancer and acute toxicities in NwGH & RC 5m Introduction: One of the common methods in radiation therapy of Breast cancer is whole breast irradiation followed by tumor cavity boost (TCB) with electron therapy. The tumor cavity boost following Whole Breast Irradiation (WBI) is well-defined and there are numerous delivery methods of radiation therapy. In our institution we don’t have the facility of electron, so our study comprised of experiencing the TCB with photons. Although photon boosts have been discouraged because of excess normal tissue toxicity. In our study we have analyzed acute skin reactions and lung doses for the level at 2Gy. Methods: Patients (n=19) of post-lumpectomy breast cancer for both left and right sided node negative were scanned for this study. Mean age for the patients was 47 year .All women were planned for 50 Gy for the whole breast irradiation via tangents followed by TCB irradiation of 10 Gy with standard fractionation. Contouring of breast, cavity, lungs and heart were done in all the cases. Mean volume of breast and cavity were 1000 cm3 and 60 cm3 respectively. These patients were observed for skin toxicity during radiotherapy as per RTOG skin toxicity criteria. Results: The mean lung volume receiving 2 Gy was 27cm3 and V20 for lung is 10% volume for 60 Gy plan. Out of total 19 patients, 75 % patients had grade-II skin reaction at treatment completion and 25 % patients had grade-I skin reaction. Mean heart dose for 60 Gy plans were 100 cGy. While dosimetric analysis it has been found that conformality, dose homogeneity index (DHI) and Tumor cavity coverage was significantly covering up to 95%. Conclusion: Although electrons can be used for TCB but in our centre electron beam therapy is not available and TCB is done with photon beam following the tangential beams. In the adjuvant treatment of breast cancer therapy, whole breast radiation followed by conformal photon boost seems to be acceptable in focus of the skin toxicity, TCB dose distribution and OAR less excessive doses. Speaker: Muhammad Aqeel Hussain (Northwest General hospital &amp; Research Centre) • 10:40 AM Atypical meningiomas: is there a role for post-operative radiotherapy? 5m **Purpose**: The optimal post-surgical management of atypical meningiomas remains controversial. The aim of this study was to review the long-term outcomes of patients with atypical meningioma following surgery and to identify potential prognostic factors for disease progression. **Materials and Methods**: From August 1992 to August 2013, 72 patients with atypical meningioma were treated at our institution. Patients with multiple tumors, neurofibromatosis type 2 or inadequate imaging follow-up were not eligible. We performed pre- and post-operative serial measurements of tumor volume from magnetic resonance imaging. We assessed age, gender, tumor location, bone involvement, extent of resection, tumor growth rates, use of adjuvant post-operative radiation therapy (PORT), and tumor volume at time of radiation therapy (RT) using uni- and multivariate analysis to determine their impact on disease recurrence. Pathology was reviewed in all patients using the WHO 2007 classification. All patients underwent surgical resection at our institution. The extent of surgical resection was established by post-operative imaging and by the surgeon’s assessment at time of surgery based on Simpson’s grading system. RT was delivered either in the adjuvant post-operative setting (PORT) or at time of tumor recurrence or progression. When used, RT was planned with a gross target volume (GTV) including any residual disease and the surgical cavity, based on a post-operative MRI or on MRI findings at time of disease recurrence. Typically, a clinical target volume (CTV) was created by adding a radial 1 cm margin without cropping-off the meningeal barriers and with inclusion of the inner plate of the skull, if applicable. An additional 3-5 mm was usually added for the planning target volume (PTV). A median dose of 54 Gy (range: 52.2-59.4) at 1.8 Gy per fraction was delivered using different techniques. In case of tumor failure, hypo-fractionated schedules or SRS were used, typically 40 Gy in 16 fractions or single fraction SRS of 8 Gy or 12 Gy, respectively. One patient received concomitant Temozolomide and RT after experiencing a third post-surgical failure. **Results**: Gross total resection (GTR) was achieved in 42 patients (58%) and subtotal resection (STR) was achieved in 30 (42%). PORT was delivered to 12 patients (28.6%) in the GTR cohort and in four (13%) in the STR cohort. The 5-year recurrence-free survival rates for GTR patients with or without PORT were 100% and 30.6%, respectively (p<0.01). Whereas disease control rate for STR patients +/- PORT were 75% and 4%, respectively (p=0.0038). Multivariate analysis revealed that the only significant independent prognostic factors for disease progression were lack of PORT and STR with a HR of 6.83 (95%CI 1.94-24) and 6.21 (95%CI 2.69-14.36), respectively. Residual tumor volume greater than 8.76 cm3 at time of RT was associated with a reduced recurrence-free survival (6.7% vs 44.4 %, p=0.0013). In patients not receiving RT, the median relative growth rate was 115.75%/year, the median absolute growth rate was 4.23 cm3/year and tumor doubling time was 9 months. Post-RT these indices were reduced to 74.5%/year, 2.49 cm3/year and 21 months, respectively. We detected tumor failure earlier on follow-up imaging studies by performing volumetric rather than planimetric measurements. We observed a median time lag between the two detection methods of failure of 18 months. At time of tumor failure diagnosis, the median disease volume on volumetric measurement was 4.89 cm3 compared to a median of 12.3 cm3 for planimetric measurement (i.e. the tumor volume will be already at least 50% larger by the time of planimetric detection), p = 0.0003. Treatments were well-tolerated no no grade 3 or higher toxicity being recorded. **Conclusion**: PORT was associated with improved recurrence-free survival in patients with GTR atypical meningioma. Our study provides new information on the importance of using volume measurement to determine tumor failure and also establishes parameters on tumor growth indices that may aid physicians in identifying patients who may benefit from a more aggressive post-operative management either on the adjuvant setting or at time of recurrence.Our results suggest that patients with residual tumor volume larger than 8.76 cm3 have an increased failure rate and should be considered for early RT. Further prospective, randomized studies are definitively needed to unequivocally establish the role of RT in atypical meningiomas.. Speaker: Luis Souhami (McGill University Health Centre) • 10:45 AM Roadmap for setting up a comprehensive state of the art radiation oncology facility at Mbingo Baptist Hospital (MBH) Cameroon 5m INTRODUCTION: Radiotherapy is an essential cancer treatment which according to experts suggestions contributes to four in ten cases where cancer is cured.1 It is a relatively cheap, safe, 2 cost-effective treatment that is associated with high levels of patient satisfaction 3. Yet radiotherapy is still lacking in many African countries. Cameroon with a population of 22.3 million inhabitants has two radiotherapy units, however these services do not get the due attention they deserve compared to other cancer treatment modalities. Considering the growing global burden of non-communicable diseases, particularly cancer, which has become a leading cause of mortality and disability in low- and middle-income countries, with more people across the world developing cancer than ever before, and with over two-thirds of all cancer-related deaths occurring in developing countries, there is an urgent need to get into action to fight for a better cancer health care in underserved areas. METHOD: The first step was a comprehensive assessment of the necessity of Radiation Therapy at a selected hospital. The Mbingo Baptist Hospital (MBH) is a 300 bed hospital located in the North West province of Cameroon in Central Africa. Due to the broad spectrum of treatment modalities being offered at this hospital and the fact that patients come in from all over Cameroon, the hospital is being developed into a referral, teaching hospital. As concerns management of cancer, surgery is being offered. There is a pathology unit and also the possibility of receiving Chemotherapy on site. These and more make MBH one of the advanced centers in Cameroon where diagnosing cancer is possible and at least two treatment options can be administered. The hospital records show that close to 2000 patients have been diagnosed of cancer. The most common cancer cases seen are breast, cervical, kaposi sarcoma and now due to a specialized training program in Head and Neck Surgery many of the patients treated in this program have some form of cancer. Unfortunately, Radiotherapy, being an inevitable treatment modality in the successful treatment of advanced stages of Head and Neck cancer and cervical cancer, does not exist at this hospital. To follow up with the establishment of a comprehensive cancer care program at MBH: - Colleagues from the US and Germany in the field of Radiation Oncology (Doctors, Medical physicists and specialists in Radiation protection) first met to assess the need and feasibility of such a project on site. - Get in contact with already existing facilities in Douala and Yaounde. - Meet with the authorities of the hospital to address the need and importance of such an infrastructure. - Involve the Dean and staff of the medical school at the Capital for cooperation. - Visit the National Radiation Protection Agency in Yaounde as concerns safety regulation standards. -Make an estimate of the financial burden required to complete such a project, work on the project’s blueprint and set a deadline for project completion. RESULTS: At the end of the journey, it was clear that MBH will not be able to carry the burden of such a project in totality. A roadmap created for establishing a comprehensive cancer center at Mbingo. Radiation oncology health professionals from Germany and the USA have committed to the project with plans to support in training of local staff. After brainstorming on different ways to assist the funding of the project, it was concluded that the diaspora and international partners get involved and making sure that MBH guarantees for a reliable stable source of power was outlined. It was also concluded that such a facility will need housing possibility also for the relatives of patients being treated at the center. To guarantee sustainability, long term strategies of collaboration via internet and Telemedicine with colleagues abroad would be mandatory. CONCLUSION: The project is at its initial stage but the initiators and driving forces of it have the strong will to see it successful. To our knowledge, this is the first attempt for a mission hospital to come up with a radiation oncology project in Cameroon and we believe the success of this project will be a motivation for others to follow. For the success of this project, we rely on financial assistance from persons and organizations of goodwill. Speaker: Rebecca Buecker (Klinikum Lippe) • 10:50 AM Radiotherapy in Hue: journey and effort 5m PHAM NGUYEN TUONG, MD, PhD* PHAM NHU HIEP, PhD, A. Prof. ** (*)Vice- director of Oncology Center, Head of Radiotherapy Department Hue Central Hospital, Vietnam (**) Director of Hue Central Hospital With a population over 90 millions, the cancer incidence rate in Viet Nam is having more than 150,000 new cases diagnosed every year. National strategy has been implementing, including the development of breast and cervical cancer screening projects, in order to control the cancer growing trend. Initiatives on improving the mortality rate of cancer patients, like enhancing hospital’s infrastructure on cancer treatment facility, allocating extra resources in training programs for medical professionals, are also in progress. Hue Central Hospital, a public regional hospital belonged to Ministry of Health located in central Vietnam providing oncology clinical services including radiotherapy to cancer patients. Oncology Center, formerly known as oncology department, was established in 1995, with just 30 beds. In the beginning, we had a Cobalt-60 radiation therapy machine which treating for about 30 cancer patients per day with 2D techniques. Over the time, the number of patients has been increasing, at peak time this machine (over 2 times of source replacement) covered the treatment for approximately 70 to 90 patients/day. Realizing the treatment overloading, and that the Cobalt-60 machine was becoming obsolete, which specially did not ensure the quality of treatment, we decided to invest a new machine. However, one problem that we had to face to was that the investment capital was limited. Although Hue Central Hospital is a public one, but then, in 2010, the government was not enough money to invest for the the upgrading. Our leaders decided to invest by the socializing model (a private company was responsible for machine installing and maintenance, hospital team was responsible for operation, 40- 60 ratio invesment income sharing). So we had got the Elekta Pricise machine for treatment. Also in that year, the project of upgrading equipments for the oncology center was launched, with ODA (Official Development Assistance) loans from Austrian government with 25 million euros worth. We realized this was an extremely valuable opportunity to strengthen the investment equipments for cancer treatment. With this great project, we equipped with new-generation LINAC radiation therapy systems of Elekta Axesse, modern planning software immobilisation devices, image guidance system.... At the same time with the deployment of equipments, the radiotherapy team has also attended many radiotherapy training courses in Austria, Singapore, Thailand ... to learn more about advanced technique radiation therapy, such as volumes contouring, planning and operation of equipment. The system was put into operation in May of 2015 at time of inaugurating the 8-storey building of oncology center. With this system we have implemented advanced techniques such as IMRT, VMAT, SRS, SRT ... and SBRT recently. Every day there are about 30 patients treated with these techniques. Looking back 20 years of developing cancer radiotherapy in Hue, we found a great effort of overcoming a lot of immanent difficulties to improve continuously the quality of radiotherapy in order to meet the increasing demands of Vietnamese cancer patients. Speaker: Nguyen Tuong Pham (Hue Central Hospital) • 10:30 AM 11:00 AM Tuesday morning - Poster Presentations - Screen3 Convener: Mr Oleg Belyakov (IAEA) • 10:30 AM Radiotherapy in Peru: shortage and inequities in access and solution proposal 5m Cancer is a health problem in the world and Peru, because of the increased incidence, from 154.5 (estimated GLOBOCAN 2012) to 216.9 (Lima Cancer Registry 2010-2012). Since 2012, the “National Plan for Comprehensive Cancer Care and Improved Access for Oncological Services in Peru” (Plan Esperanza)of Health Ministry offers full coverage of treatment cost by the Seguro Integral de Salud (SIS). The lack of geographical access is shortage and centralization of radiotherapy, with 7 machines in the whole country. It causes treatment delay or abandon due to the long waiting times, high transportation costs, stay, food and laboral absentism of the patient and relatives, among other issues. The purpose of this poster is to propose the decentralization of public radiotherapy in Peru, improving geographic and economic access for cancer patients. SIS affiliates in the country at September 2016 count 17´497,944. Lima is on first place with 22.5%. The 6 northern and southern regions have 29.7% and 17%, respectively. Jungle regions with only have aerial access, Loreto and Ucayali; represent 4.9 and 2.4% respectively. According the IAEA and WHO reccomendations, Peru need 52 Megavoltaje units(MU), distribuited as follows: 11.8 in Lima, 3.6 in Cajamarca, 3.5 in Piura, 3.1 in La Libertad, 2.8 in Cusco, 2.6 in Loreto, 2.5 in Puno, 2.3 in Junin and Ancash, 2.2 in Lambayeque, 2.1 in San Martin, 2.1 in Huanuco, 1.6 in Ayacucho, 1.5 in Arequipa, 1.3 in Callao, 1.2 in Ucayali, 1.1 in Amazonas and Apurimac, 1 in Huancavelica and Ica, 0.5 in Pasco, Tumbes and Tacna, 0.3 in Madre de Dios and Moquegua. We propose in short time (first phase) to setting up of radiotherapy facilities in the hospitals and to distribute 37 MU in 7 regions grouped considering population, preexistence of other oncological services and land transport facilities: 4 MU in Piura, 4 MU in Lambayeque, 2 MU in Loreto, 3 MU in La Libertad, 12 MU in Lima, 4 Mu in Junin, 4 MU in Cusco and 4 MU in Arequipa (see figure). One unit of high dose rate brachytherapy per installation is highly recommended, considering high gynecological cancer incidence. In the medium-long term (second phase), the facility program should continue and expand to other regions with population demand and availability of the other oncological services (chemotherapy, oncologic surgery), such as Cajamarca, San Martin, Ancash, Puno and others. Speaker: Paola Carolina Guerrero-Leon (Ministry of Health, Peru) • 10:35 AM Clinical outcomes and beam quality correlations on skin cancer radiotherapy management in Mexico: A national institute experience: 2000-2013 5m **Purpose**: To evaluate the outcome of radiotherapy for nonmelanoma skin cancer of Mexican population in terms of the radiation therapy modality received and local relapse-free survival. To show the cost-effectiveness benefit of kV therapy compared to linac based electron therapy.**Introduction**: Nowadays non-melanoma skin cancer (NMSC) is the most frequent malignant disease. Radiotherapy (RT) is a useful noninvasive alternative for some types of NMSC. It represents a valuable method for a minority histologically confirmed NMSC, in patients older than 60 years, where the patient’s medical conditions contraindicate surgery procedures, or if the patient refuses surgery or if surgery would result in unacceptable morbidity. We summarize the Mexican population epidemiological data of NMSC patients of thirteen years from a main reference cancer center of Mexico, Instituto Nacional de Cancerología (INCan). RT modalities for NMSC are brachytherapy (BT), superficial x-ray (ST), electron beam (ET) and orthovoltage radiotherapy (OT). We studied the role of different RT modalities mainly kV therapy (ST/OT) vs ET or a combination of different beam qualities.The use of kV units for RT in Mexico has been decreasing in last decades. Nowadays only 6 kV units are installed, 3 in private hospitals and 3 in public hospitals as IMSS (recently in disuse), INCan (now in disuse) and INCMNSZ (recent acquisition and operation). On the other hand, linear accelerators with a wide range of high energy (MeV) electron beams (26 units) are the choice of most facilities for treating superficial tumors including NMSC. The main goal of this study was to compare the efficacy, considered as overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS) in terms of the quality of radiation beam utilized. A simple cost-effectiveness study was carried on as well.**Material and Methods**: We made a retrospective chart review of RT management on NMSC on a period of 13 years at the INCan. A total of 1224 patients treated with RT (palliative, radical or post-surgical intention) during 2000 to 2013 for NMSC were collected. Patient data included demographics (age at treatment date, gender, occupation, histology, surgical treatment, zone and lesion diameter). The median age was 72 years and 56% were female patients. Most patients (57%) were treated with kV therapy, the rest with ET (23%) and a combination of Co-60, electron and orthovoltage beams (20%). 24.1% of patients were treated with surgery, followed by RT and 67.2% were treated only with RT. We compared two groups of patients those who were treated with kV therapy and those treated with ET. All patients were treated with one single electron beam (4-6 MeV) in a Varian Linac or kV photon beams (50-200 kV) in a Gulmay kV unit. Radiotherapy data included the total absorbed dose (30-70 Gy) and fractionation scheme (10-35 fractions). The mean operational costs of 15 fractions in 2015 were$4,448.00MXN and$17,751.30MXN for kV and ET, respectively. We studied the success/fail according to local failure and survival rate. U-Mann Whitney and Chi2 tests were used in order to find independency and correlations between groups. Kaplan-Meier curves were obtained for estimation of overall, disease-free and recurrence survival. Multi variate analysis was made also in order to analyze other factors contributing the outcome such as surgery. The statistical analyses were performed using v.23 of IBM SPSS Statistics software.**Results and conclusions**: The mean follow-up was 48 months. Population balance in terms on histological subtype were 75% basal and 30% epidermoid. There are few reports illustrating the outcomes of RT for NMSC. Our review includes a heterogeneous sample of beam quality management and it could be the first one in our country. We found a significant correlation (chi2 test, p<0.03) when we compare kV vs. ET in terms of clinical outcomes. The test of equality on free-recurrence survival distributions for different levels of RT modality had a significant result (Log-Rank Mantel-Cox p=0.019) with a best median of 15 months for kV therapy (12 months for ET and 9 for ET+kV). This finding suggests that the kV therapy should be the best decision for RT in NMSC. Moreover, our simple analysis comparing the costs and benefits of each modality enhance this conclusion, being the cost of ET triple expensive than kV therapy. Our finding suggests that keeping and increasing kV units in our country is necessary for a not cure rates reduction alternative. It is important to recognize that this simple technology is allocated to treat superficial lesions and discharge a linac machine for more complex and costly treatments.
Speaker: Evangelina Figueroa-Medina (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (México))
• 10:40 AM
The past, present and future directions of radiotherapy in Asia: linking technology and the fight against cancer 5m
Speaker: Miriam Joy Calaguas (Jose R. Reyes Memorial Medical Center-Department of Radiotherapy, Philippines)
• 10:30 AM 11:00 AM
Tuesday morning - Poster Presentations - Screen4
Convener: Mr Oleg Belyakov (IAEA)
• 10:30 AM
Automated treatment planning system commissioning: error reduction and improved efficiency for low and middle income countries come Countries 5m
In this work we propose standardization and automation of treatment planning system (TPS) commissioning for the purpose of error reduction, improved efficiency, and cost savings. This “new era of automation” is relevant and necessary given the global call-to-action for improving access to and investment in radiotherapy facilities for underserved populations in developing regions worldwide. As new treatment centers with limited resources are brought online, the global medical physics community will benefit from our proposed automated commissioning process that utilizes an application program interface and preloaded CPU with standard premodeled beam data, digital phantoms, and automated commissioning test suite to streamline verification testing and benchmark for ongoing QA. Current conventional procedures for treatment planning system commissioning are compared to the proposed automated commissioning process and assessed for potential risks and failures.
Speaker: Amy Wexler (University of Missouri - Columbia)
• 10:35 AM
Status of Radiotherapy and results of TLD postal dose quality audit in Ukraine 5m
Speaker: Tetiana Pidlubna (State Clinical Hospital Feofaniya)
• 10:40 AM
Challenges and solutions of establishing advanced radiation oncology services in low and middle income (LMI) countries 5m
Speaker: Belal Moftah (King Faisal Specialist Hospital and Research Center)
• 10:45 AM
Broken machines or broken systems – The ugandan experience, on accessing/maintaining radiotherapy services, in low and middle-income countries 5m
Speaker: Awusi Kavuma (Uganda Cancer Institute)
• 10:50 AM
Radiotherapy utilization in developing countries: an IAEA study. 5m
Speaker: Eduardo Rosenblatt (IAEA)
• 10:30 AM 11:00 AM
Tuesday morning - Poster Presentations - Screen5
Convener: Mr Oleg Belyakov (IAEA)
• 10:30 AM
Challenges and solutions, advantages and disadvantages of launching 1st 3-Dimensional brachytherapy in a developing war-torn country (Iraq) using Co-60 High Dose Rate (HDR) source 5m